High dependency (23/1/13)
When I first arrived at Kijabe Hospital, there were two options for care if you were a sick child – admit to the ward, where there is one nurse for 12-20 patients depending on the workload, or admit to intensive care. The intensive care unit had 5 beds for the whole hospital – so taking a bed for a child meant taking a bed away from an adult who also needed one. It has often been a Solomonian task – if I send this child to the ward, will they be watched closely enough? But if I send them to ICU, will someone else not get the care they need and die? There were many 5pm episodes of walking around ICU with an adult surgeon and an obstetrician, each of us asking – which if our patients needs this bed the most?
Several months ago, the pediatric medical and surgical teams got together and decided – we need to convert one of our 4-bed pediatric bays into a 3-bed high-dependency unit (HDU). Again, a tough decision – we lose a pediatric bed, in a ward that is always full with beds in the hallway, but we gain an area where 3 children can be monitored by a single nurse. And we all decided that it was worth it.
Bethany Kids donated the money – around $10,000 dollars to purchase monitors, buy beds, pipe in oxygen and suction where none existed. A ludicrously small amount for a renovation by western medical standards, but insurmountable in Kenya without external donations. Erik, the head of pediatric surgery and a good friend of ours, gave the project the go ahead and we waited for the overworked engineering team to have the space in their always-full project schedule to start the conversion process.
So finally, a couple of weeks ago, we were able to welcome our first patients to the new HDU. On a day when intensive care was already full of adults and children, it welcomed a child with severe malnutrition, one with liver failure and another with critically high blood pressure. Our pediatric ward nurses, lacking confidence in caring for the sickest children, are being trained by our intensive care nurses, increasing their skills and confidence. And already, our first survivor – the severe malnutrition navigating the first dangerous days of high dependency care to graduate to the ward, and finally home where our nutrition team will follow her and her family to make sure they have what they need to continue to thrive.
It might not seem like much, but 3 extra beds for us is just one more step in the right direction. The direction of being able to more closely monitor a child who may be alive in the morning because we were able to detect their falling blood pressure, rather than finding them dead in the morning at 4am in between vital sign checks. The direction of training our nurses and doctors to care for a child who’s just a little bit sicker than the others, increasing their confidence and competence for the good of so many more children.
And so we continue – the high dependency of these kids mirroring our high dependency on God and each other as we navigate this unending journey of serving poor and vulnerable kids in Kenya.